A Discharge Vital Sign Documentation Improvement Initiative in the Pediatric Emergency Department.

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  • Additional Information
    • Source:
      Publisher: American Academy of Pediatrics Country of Publication: United States NLM ID: 0376422 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1098-4275 (Electronic) Linking ISSN: 00314005 NLM ISO Abbreviation: Pediatrics Subsets: MEDLINE
    • Publication Information:
      Publication: Elk Grove Village Il : American Academy of Pediatrics
      Original Publication: Springfield, Ill., Thomas.
    • Subject Terms:
      Documentation* ; Patient Discharge*/statistics & numerical data ; Vital Signs*; Emergency Service, Hospital/*standards ; Hospitals, Pediatric/*standards; Child ; Electronic Health Records/standards ; Humans ; Length of Stay ; Patient Readmission/statistics & numerical data ; Quality Improvement ; Retrospective Studies
    • Abstract:
      Background and Objectives: Vital signs are important data elements in the pediatric emergency department (PED). The presence of unexplained tachycardia at discharge has been associated with patient return to the PED and subsequent admission. Our aim for this study was to increase the percentage of patients discharged with a complete set of vital signs, when indicated, from 22% to 95% by June 30, 2018.
      Methods: A multidisciplinary team developed key drivers, and data were collected by using a retrospective chart review. Outcome measures were the percentage of patients with discharge vital signs and 72-hour returns to the PED. Balancing measures included PED length of stay (LOS) and hospital admissions. Data were compiled from a chart review 7 times monthly; all charts were of patients presenting to the PED during the days being reviewed. An annotated p-chart was used to analyze the data.
      Results: Data were collected for 18 months, including baseline data from July to September 2017, during which time 22% of patients had discharge vital signs. Targeted quality improvement methodology initially improved discharge vital signs to 41%, and then to 85%, which has been sustained for 7 months. There was no change in 72-hour return PED visits or LOS. Although absolute hospitalizations remained stable, the percentage of patients admitted increased.
      Conclusions: Targeted quality improvement methodology is associated with sustained improvement of indicated discharge vital signs for patients discharged from the PED. This improvement was not associated with reduced return PED visits, prolonged LOS, or increased hospitalization.
      Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
      (Copyright © 2019 by the American Academy of Pediatrics.)
    • Publication Date:
      Date Created: 20190817 Date Completed: 20200116 Latest Revision: 20200116
    • Publication Date:
      20221213
    • Accession Number:
      10.1542/peds.2019-0436
    • Accession Number:
      31416826